Hearing aids are the most effective and potent therapeutic tool available for the vast majority of hard of hearing people. It is agreed that they are a crucial and necessary component in any effort designed to mitigate the consequences of a hearing loss. But some problems caused by a hearing loss either cannot be helped by a hearing aid, or the aid by itself may be inadequate, as the two following examples will illustrate:

1. Many hard of hearing people have difficulty understanding a lecture or a sermon, or following the dialogue in a theater performance or movie house. In these types of locations, any large-area assistive listening device can further improve comprehension beyond that possible with hearing aids.

2. Hearing aids are not designed to serve as an alarm clock, and unless the hard of hearing sleeper wears the hearing aid all night (not a good idea), an audible alarm may not wake this person up. Hearing aids, in other words, while necessary for hard of hearing people, cannot serve purposes for which they were not designed.

In recent years, a entirely new class of Hearing Assistance Technologies (HAT) have been developed. These include the three major types of large-area assistive listening systems (Induction Loop, Infra-Red (IR), and FM Radio), personal FM systems, telephone amplifiers and TTY's, TV listening devices and captions, various types of conference and hand-held microphones, and a large number of signaling and warning devices (e.g. visual or vibratory alarm clocks and smoke alarms, telephone and doorbell lights, motion detectors, etc.). Some HAT are separate units from hearing aids (e.g. signaling and warning devices, FM and IR receivers) and can stand alone, while others are designed to work with or through a hearing aid (e.g. telecoil or direct audio input capability). Direct audio input (DAI), for example, is a way of avoiding electromagnetic interference while accessing assistive listening devices (e.g. the audio output from a computer). There are many types of HAT; one only has to consult one of the catalogs available (check Hearing Loss - the Journal 0f SHHH) to appreciate their full range.

Chances are that many hard of hearing people have need for such a device, at least at some times and for some purposes. However, hard of hearing people are not generally aware of the existence of these devices nor understand how their effective use can improve awareness and accessibility to acoustic signals, either through substitution (i.e. converting the sound into light, vibration, or text) or sound enhancement (e.g. a personal FM or TV listening system ). SHHH suggests that all hard of hearing people receive a careful "needs assessment" during the hearing aid selection process. This should include a check-list of various kinds of communication situations to ensure that no important ones are overlooked. It is necessary to determine a person's communication needs at home, on the job, during recreational, social, and religious activities, while traveling for fun or business, or any other kinds of situations unique to the individual. Such check lists have already been developed and are being used by leading audiologists. Whether a detailed interview technique or a check list is used, the goal is to ensure that the possible usefulness of HAT be thoroughly explored with each potential hearing aid candidate.

Furthermore, SHHH suggests that dispensers make specific HAT recommendations, in much the same way they do with hearing aids, and assist their patients to learn how to use them, again in the same way they do with hearing aids. The introduction to, and assistance with HAT can, SHHH suggests, be included into the hearing aid selection process, most logically during the hearing aid trial period (see 1 below) and within the subsequent hearing aid orientation period (see 2 below). Because of the potential benefits of HAT for hard of hearing people, SHHH recommends that all hearing aid dispensers incorporate the evaluation and dispensing of HAT as an integral component of their practice.

1) In a previous position paper, SHHH has recommended that dispensers provide their clients with a minimum of a 60 day trial period.

2) In a previous position paper, SHHH has recommended that all hearing aid dispensers offer their clients the opportunity to participate in a group.